Perspective on COVID-19 Treatment Options

Throughout this pandemic I often talk about risks and benefits. We know so little and have so few clinical guidelines that decision making is frequently based on judgment more than hard facts.

Increasingly, we are hearing about promising treatment options for COVID-19. The most promising appears to be hydroxychloroquine and Chloroquine. There have been remarkable turnarounds, especially when paired with azithromycin.

Using them immediately should we test positive, or even just have a dry cough and low-grade fever is very tempting. After all, they are FDA approved and have been used for decades, so why wouldn’t we use them off label for everybody until science proves their value with COVID-19?

In the case of a patient who is hospitalized or deteriorating after a week of being sick with COVID-19, the benefit of these unproven medications probably far exceeds the risk.

But what about the vast majority of people who will recover from a relatively mild illness without difficulty?

First, consider that we really don’t know the safety of these medications in the presence of COVID-19. We do know that potentially serious heart arrhythmias are known to occur with hydroxychloroquine and Chloroquine, with the risk amplified with azithromycin. What if this virus also promotes arrhythmias? We simply don’t know, and that could be devastating.

Also, these are not completely innocuous medications, especially Chloroquine. The toxic dose of Chloroquine is only twice that of its therapeutic dose. The lethal dose is four times that of the therapeutic dose. To put that into perspective, that would be like getting sick from 1300 mg of Tylenol, and dying from just 2600 mg. That’s just five extra strength Tylenol!

Lastly, there are many drugs being developed to treat COVID-19. You do not qualify for these trials if you had taken hydroxychloroquine. Therefore, if you take hydroxychloroquine for an innocent viral illness this spring or even mild COVID-19, you would not qualify to participate in one of those trials if you get seriously ill this fall.

There are always potential consequences to every choice we make. Don’t react in fear. If you have a mild viral illness or even a mild version of COVID-19, think twice about requesting these experimental treatments…. for now.